Resource Center for Palliative Care of People Living with HIV/AIDS (PLWH)

The problem of providing HIV-infected people and those who suffered from other serious diseases with complex medical and social aid is becoming increasingly relevant from year to year. The nursing curricula however do not include to an appropriate extent any courses on palliative aid and care for chronic patients, while the nursing of those with HIV/AIDS is almost absent from them. There is still no state-established standard for palliative aid.

In September 2007, the Russian Ministry of Public Health and Social Development issued an Order on Measures for Organizing Palliative Aid to the HIV-infected. It provides for 'cooperation between medical institutions, social protection centers and public organizations in giving medical aid to the HIV-infected in constituent regions of the Russian Federation. Patients with HIV-infection, who suffer from intensive pain and other symptoms leading to temporary disorders in their physical and mental condition and to the need for individual care, shall be hospitalized in palliative aid wards not only in hospitals for infectious diseases, tuberculosis and narcology but also general clinics'.

St. Dimitry's Sisterhood in Moscow has been engaged in providing palliative aid for several years. It has accumulated a considerable practical experience. In addition, it has elaborated a palliative aid training program. Under this program, training seminars have been held in many regions in Russia (The Newsletter has reported on St. Dimitry's Sisterhood's palliative aid service and training seminars in several issues - Ed.).

In order to broaden the practical, informational and educationsal work for palliative aid it has been decided to set up a special Resource Center for Palliative Care of PLWH.

To this end, an agreement on non-commercial cooperation was signed on January 9, 2008, between St. Dimitry's Sisterhood, St. Alexis' Central Clinic of the Moscow Patriarchate and St. Dimitry's Nursing School under the Moscow City Health Department. Its purpose is to set up and equip a training palliative aid ward for nursing declining chronic patients as well as facilities for practice-orientated seminars and a lecture hall for teaching palliative aid skills to nurses, students and volunteers.

Since it was St. Alexis Clinic that became the basis for the Resource Center, it would be appropriate to inform the readers about the clinic itself and its history.

The buildings of the clinic were built in 1903. The construction was fully financed by sponsor merchants Ivan Medvednikov and his wife Alexandra. At that time it was called 'Medvednikov Alms-House and Clinic for Serious and Incurable Cases'. For its time, it was one of the best-equipped hospitals.

It was a compound consisting of medical wards, an apartment building for the staff, an orphanage, auxiliary facilities, a chapel and two churches. Its solemn opening on December 17, 1903, was attended by the General-Governor of Moscow and Grand Duchess Elizabeth Fyodorovna. Metropolitan Vladimir of Moscow, who was to become a holy martyr, performed the rite of the blessing of the new charitable institution. The names of the benefactors, Ivan and Alexandra, are still mentioned during the liturgy at the hospital churches.

In the 1920s the hospital churches were closed and the Medvednikov Clinic itself was renamed as Clinic No. 5. The divine services in the church were resumed in 1992 when the hospital was handed over to the Church.

In 1992 the hospital was transformed into St. Alexis's Central Clinic of the Moscow Patriarchate. At present it is a diversified modern hospital. It has 220 beds and surgical, neurological, therapeutic and intensive care departments. St. Alexis's Clinic is devoted not in word but in deed to reviving the traditions of Russian medicine which combines high professionalism with Orthodox charity.

To help develop this unique social church project, a Patrons Board was established for the clinic. In 2005 it came to be directed by His Holiness Patriarch Alexy II of Moscow and All Russia, who believes the establishment of a modern church hospital to be 'the most important project of the Russian Orthodox Church'.

'As it is the first and the only church hospital, it should meet the highest criteria. I wish it were a model for state-run and private hospitals', the Patriarch said.

Working in St. Alexis's Clinic are highly qualified medical doctors. Many of them have served there for several decades and new specialists are coming.

St. Alexis's Clinic is also an authoritative scientific center. There are three chairs of the Russian State Medical University and its neurological and medical rehabilitation ward is one of the best in Moscow. There is also a consultative and diagnostic center which offers medical examination and consultation with doctors of high category specializing in various diseases.

The clinic also serves as a basis for St. Dimitry's Orthodox Nursing School. Its students are engaged in nursing the clinic's patients.

Though it does not specialize in infectious diseases, it also offers treatment to HIV-infected patients and those with hepatitis B and C. The palliative aid skills taught by the Resource Center are also intended for this kind of the clinic's patients.

The Resource Center of St. Dimitry's Sisterhood works in two principal areas: actual nursing and training for palliative aid. These areas are closely interconnected as working in them are the same teams of specialists.

The training work consists in holding training seminars at the Center, developing and improving curricula, publishing educational aids and developing the professional competence of nurses.

Training seminars are held according to the same programs as those of extra-mural seminars in regions but with extended practical lessons at the patient's bed.

The Resource Center offers training to sisters of mercy, junior nurses, volunteers from sisterhoods in Moscow and sisters who come from other regions for practical training and exchange of experience. It is planned to offer a special training course for nurses working at state-run hospitals under the Moscow City Center for Preventing and Combating AIDS.

The Resource Center gives people nursing aid at its palliative aid ward. About 60 patients a year have an opportunity to be treated there. The principal tasks of the palliative aid ward are:

• to give palliative aid to HIV-infected patients with clear functional disorders leading to a limited ability of self-service and a need for nursing;
• to conduct symptomatic, etiotropic and pathogenetic therapy;
• to carry out a complex rehabilitation treatment including pharmaceutical therapy, physiotherapy, medical exercise and massage.

The palliative aid ward works not only to give aid to chronic patients in declining condition, such as HIV-infection complicated by somatic pathology but also to refine the algorithm and practical skills for this kind of aid.

After a patient has undergone treatment at the palliative aid ward, the nursing support for him does not stop. Discharged HIV-patients and their families continue to be given complex palliative aid through the efforts of St. Dimitry's Sisterhood's visiting nurses.

The work of the Resource Center has already provoked a considerable interest in Russian regions. Thus, five leading sisterhoods in St. Petersburg have expressed readiness to set up palliative aid wards at city hospitals and to work with serious patients in them. To be trained for this kind of work, sisters of mercy will take a training course at the Resource Centre of St. Dimitry's sisterhood.

Olga Yegorova
Senior Nurse
Home-nursing service
St. Dimitry's Sisterhood
Tel/Fax: (495) 236-44-78;
e-mail: patr@yandex.ru

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